Provider Assurance & Integrity Specialist

Southern Cross Health Insurance; Auckland; Hybrid; NZD 90,000 - 120,000; Full time

Benefits offered by this job

Five days wellbeing leave

Health insurance for you and family

Life insurance cover and discounts on?

Extra parental leave benefits

Volunteer day and wellbeing programme

Job summary

Southern Cross Health Insurance is seeking a Provider Assurance Specialist within the Healthcare Partnerships team in Auckland. You will work with a range of providers to ensure AP terms are understood and applied, and will guide investigations and audits to strengthen controls.

You’ll bring experience in claims assurance, FAWE investigations, and strong health-insurance product knowledge, with excellent communication and problem-solving skills to support robust provider governance.

Qualifications

• Experience across insurance, financial services, medical or health sector environments.
• Experience investigating fraud, abuse, waste and error (FAWE).
• Strong clinical literacy relevant to health insurance services.
• Knowledge of policy terms and Southern Cross products is advantageous.
• Well-developed critical thinking and problem-solving ability.
• Strong communication, training and influencing skills.

Responsibilities

• Run and oversee AP onboarding with providers and confirm obligations.
• Meet with providers to refresh AP understanding and discuss eligibility criteria and controls.
• Carry out quality assurance checks on provider controls.
• Investigate signals of potential claims leakage and analyse patterns.
• Advance investigations into formal audits and follow up corrective actions.
• Assess whether approvals and claims meet policy terms.
• Help design and improve our controls to keep leakage within appetite.
• Build relationships with Healthcare Partnerships, Member Services, Risk and Compliance.

Skills

Insurance experience

FAWE investigations

Clinical literacy

Health insurance product knowledge

Strong communication

Job description

Southern Cross Health Insurance is seeking a Provider Assurance Specialist within the Healthcare Partnerships team in Auckland. You will work with a range of providers to ensure AP terms are understood and applied, and will guide investigations and audits to strengthen controls.

You’ll bring experience in claims assurance, FAWE investigations, and strong health-insurance product knowledge, with excellent communication and problem-solving skills to support robust provider governance.